Clinical study of hyperventilation therapy in severe traumatic brain injury by transcranial doppler monitoring

doi:10.3877/cma.j.issn.1674-6880.2019.05.004

Abstract

Abstract:

Objective

To investigate the effect of appropriate hyperventilation therapy based on transcranial doppler (TCD) monitoring in patients with severe traumatic brain injury (sTBI).

Methods

Totally 59 sTBI patients were divided into the control group (30 cases) and experimental group (29 cases) randomly. Patients in the control group were treated with hyperventilation, and patients in the experimental group received mild hyperventilation ventilation therapy according to the cerebral vasospasm (CVS) monitored by TCD. The blood flow mean velocity (Vm) and variation of Vm (ΔVm) before and after treatment in the middle cerebral artery (MCA) were detected. At the same time, patients in the two groups were further divided into the non-CVS group (Vm<120 cm/s), mild CVS group (120 ≤ Vm<140 cm/s) and moderate- severe CVS group (Vm ≥ 140 cm/s). The ΔVm among each subgroup was compared. The effect after 6 months of treatment between the two groups was assessed by the Glasgow outcome scale (GOS).

Results

The ΔVm was much higher in the experimental group than in the control group [22.0 (13.0, 39.5) cm/s vs. 10.0 (7.0, 26.3) cm/s, H = 2.527, P = 0.012]. The ΔVm with different CVS degrees between two groups was significantly different (H = 20.276, P = 0.001). In the experimental group, the ΔVm was much higher in the mild CVS group and moderate- severe CVS group than in the non-CVS group [23.0 (21.5, 41.0), 40.0 (22.5, 52.0), 13.0 (9.8, 18.0) cm/s], and it was highest in the moderate-severe CVS group (all P<0.05). For patients with moderate-severe CVS, the ΔVm was also much higher in the experimental group than in the control group [40.0 (22.5, 52.0) cm/s vs. 9.0 (8.0, 31.0) cm/s, P<0.05]. The GOS score after 6 months of treatment was much better in the experiment group than in the control group (u= 2.059, P= 0.045).

Conclusion

The hyperventilation therapy based on TCD monitoring can play a pivotal role in alleviating CVS and improving the efficacy of sTBI patients.

Key words: Ultrasonography, doppler, transcranial, Hyperventilation, Craniocerebral trauma

Kai Zhao, Lin Han, Na Hu, Xiaoliang Du, Chunlin Li, Huaqiu Zhang. Clinical study of hyperventilation therapy in severe traumatic brain injury by transcranial doppler monitoring[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(05): 306-310.

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References 21

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组别		例数	ΔVm
对照组		?	?
?	无CVS	13	9.0（6.0，16.0）
?	轻度CVS	11	19.0（7.0，34.0）
?	中重度CVS	6	9.0（8.0，31.0）
实验组		?	?
?	无CVS	14	13.0（9.8，18.0）
?	轻度CVS	10	23.0（21.5，41.0）^a
?	中重度CVS	5	40.0（22.5，52.0）^abc

组别		例数	ΔVm
对照组		?	?
?	无CVS	13	9.0（6.0，16.0）
?	轻度CVS	11	19.0（7.0，34.0）
?	中重度CVS	6	9.0（8.0，31.0）
实验组		?	?
?	无CVS	14	13.0（9.8，18.0）
?	轻度CVS	10	23.0（21.5，41.0）^a
?	中重度CVS	5	40.0（22.5，52.0）^abc

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